Emergency Department (ED) overutilization is a national concern in the U.S. and abroad. Overutilization is costly to the healthcare system and a suboptimal use of limited healthcare resources. The problem is poorly understood, as evidenced by many publications conflicting findings. The goal of this study was to improve clarity and to suggest direction for future study of the problem. Data was collected from health records and patient interviews. The results of the study suggest direction, but also highlight the opportunity for further research. In the two rural health settings studied marketing and community engagement are the two most decisive recommendations. Recommendations will differ in most communities based on health literacy and traditions. Rural communities have higher rates of confounding social determinants of health, but they differ from community to community. Progress can be made, but it will also be necessary to help communities overcome these barriers to improve the health status of the populations and health literacy of the individual citizens.
